BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) research has primarily involved case series reports of low-risk procedures. Distal pancreatectomy has significant postoperative morbidity and would permit rigorous examination in a controlled trial setting. OBJECTIVE: To compare endoscopic transgastric distal pancreatectomy (ETDP) and laparoscopic distal pancreatectomy (LDP). DESIGN: Prospective, randomized, controlled trial. SETTING: Academic hospital. SUBJECTS: Forty-one swine, 28 block randomized. INTERVENTIONS: LDP was performed with 3 trocars and stapled transection of the pancreas. ETDP was performed via a gastrotomy, with 1 trocar for visualization, by using endoloop placement, snare transection, and purse-string gastrotomy closure. MAIN OUTCOME MEASUREMENTS: Clinical examination, CT, serum chemistries, necropsy, peritoneal fluid analysis, and histologic examination. RESULTS: Swine were survived for 8 days. The procedure time for ETDP was significantly greater than for LDP (1:52 vs 0:33 [hours:minutes]; P = .00). Pancreatic specimen weight was similar (4.1 g vs 5.5 g; P = .108). Postoperatively, 26 of 28 animals thrived. In the LDP group, 1 death caused by pancreatic leak and renal failure occurred on day 1. In the ETDP group, 1 death caused by pneumothorax occurred intraoperatively. The necropsy, CT, and histologic examinations revealed focal resection-margin necrosis in 3 to 7 swine in the ETDP group with no proximal necrosis or pancreatitis. The groups were equivalent clinically, by survival, and by serum and peritoneal fluid analysis. The gastrotomy closure was associated with small serosal adhesions, but no gross abscess or necrosis. LIMITATION: Animal study. CONCLUSIONS: In the largest controlled trial of NOTES orifice surgery to date, there was no clinical or survival difference between NOTES and laparoscopic approaches.
BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) research has primarily involved case series reports of low-risk procedures. Distal pancreatectomy has significant postoperative morbidity and would permit rigorous examination in a controlled trial setting. OBJECTIVE: To compare endoscopic transgastric distal pancreatectomy (ETDP) and laparoscopic distal pancreatectomy (LDP). DESIGN: Prospective, randomized, controlled trial. SETTING: Academic hospital. SUBJECTS: Forty-one swine, 28 block randomized. INTERVENTIONS: LDP was performed with 3 trocars and stapled transection of the pancreas. ETDP was performed via a gastrotomy, with 1 trocar for visualization, by using endoloop placement, snare transection, and purse-string gastrotomy closure. MAIN OUTCOME MEASUREMENTS: Clinical examination, CT, serum chemistries, necropsy, peritoneal fluid analysis, and histologic examination. RESULTS:Swine were survived for 8 days. The procedure time for ETDP was significantly greater than for LDP (1:52 vs 0:33 [hours:minutes]; P = .00). Pancreatic specimen weight was similar (4.1 g vs 5.5 g; P = .108). Postoperatively, 26 of 28 animals thrived. In the LDP group, 1 death caused by pancreatic leak and renal failure occurred on day 1. In the ETDP group, 1 death caused by pneumothorax occurred intraoperatively. The necropsy, CT, and histologic examinations revealed focal resection-margin necrosis in 3 to 7swine in the ETDP group with no proximal necrosis or pancreatitis. The groups were equivalent clinically, by survival, and by serum and peritoneal fluid analysis. The gastrotomy closure was associated with small serosal adhesions, but no gross abscess or necrosis. LIMITATION: Animal study. CONCLUSIONS: In the largest controlled trial of NOTES orifice surgery to date, there was no clinical or survival difference between NOTES and laparoscopic approaches.
Authors: Anders Meller Donatsky; Luise Andersen; Ole Lerberg Nielsen; Barbara Juliane Holzknecht; Peter Vilmann; Søren Meisner; Lars Nannestad Jørgensen; Jacob Rosenberg Journal: Surg Endosc Date: 2012-01-12 Impact factor: 4.584
Authors: Ronan A Cahill; Mitsuhiro Asakuma; Joseph Trunzo; Steven Schomisch; David Wiese; Sukamal Saha; Bernard Dallemagne; Jeff Marks; Jacques Marescaux Journal: J Gastrointest Surg Date: 2009-12-09 Impact factor: 3.452
Authors: Jan Martínek; Ondřej Ryska; Tereza Filípková; Radek Doležel; Stefan Juhas; Jan Motlík; Monika Holubová; Vladimír Nosek; Barbora Rotnáglová; Miroslav Zavoral; Miroslav Ryska Journal: World J Gastroenterol Date: 2012-07-21 Impact factor: 5.742